Autism Spectrum Disorder and Visual Impairment (ASDVI)

1. Autism Spectrum Disorder and Visual Impairment (ASDVI)

2. Disclaimer • The information in this Power Point is not original. It is a compilation of material brought together to help people understand Autism and Visual Impairment.

3. What is the Autism? • Autism is a neurological brain disorder that profoundly affects a person’s ability to communicate, form relationships with others and respond appropriately to their environment. Gense and Gense, 2005

4. ASD • Autistic Spectrum Disorder (ASD) is the latest term for autism that tries to demonstrate that there is a continuum or spectrum from mild to severe of communication styles, relationship abilities and responses to the environment.

5. ASD • ·No single behavior identifies an ASD • ·Behavioral Characteristics range from mild to severe • ·Cognitive abilities range from intellectually gifted to severe impairments. • ASD includes autism, pervasive developmental disorder (PDD), Asperger’s syndrome, Rett syndrome and Fragile X disorder.

6. ASD Behavioral Characteristics • ·Impairments in communication.Significant delay in or the absence of speech. Language is repetitive (echolalia) or person desire to talk about the same topic repeatedly. • ·Pronoun reversal • Shows little interest in other people’s topics.

7. Pronoun Reversal • Pronoun reversal is a language abnormality common in the speech of autistic children. Children refer to themselves as "he", "she", or "you", or by their own proper names. Pronoun reversal is closely linked to echolalia. Since autistic children often use echolalic speech, they refer to themselves as they have heard others speak of them and misapply pronouns. • For example: • Parent: What are you doing, Johnny? • Child: He's here. • Parent: Are you having a good time? • Child: He sure is.

8. If speech continues to develop more normally, this pronoun reversal might be expected to disappear. In many instances, however, it is highly resistant to change. Some children have required very extensive training even after they have stopped parroting the phrases of other people. Children understand language at a higher level than their spoken language.

9. Language Implications • 1. Check out whether child understands what he/she is saying (e.g., “what does that mean?”) • 2. Use controlled language. (e.g., short, concrete phrases with time between statements to allow for processing) • 3. If student has vision, try to provide some information visually; if not, provide information tactually.

10. Communication Implications • 1. Direct instruction in the actual setting is key. • 2. Identify clear, concrete rules that the child needs to follow in specific situations. • 3. Social stories can be helpful in providing a child with a script to follow. http://www.thegraycenter.org/store/index.cfm?fuseaction=page.display&page_id=30

11. Behavioral Characteristics • Impairments in social interaction.Individuals may appear aloof, indifferent or “locked in their own world” they lack emotional reciprocity and often have poor relationships with their peers.

12. Behavioral Implications • 1. Recognize that the routines and self-stimulatory behavior are the things that the child understands best and may serve as a “life-preserver” for the child. It is the child’s retreat to his comfort zone. • 2. The child’s reliance on such behaviors will tend to increase in times of stress and anxiety (e.g., transition, lack of clear expectation, challenges). Ask yourself “why is the child engaging in this now?” • 3. Identify a time when the child can engage in his self-stimulatory behavior; tighten up the structure, schedule, and routine to decrease anxiety and increase non-verbal information.

13. Social Implications • 1. Recognize that the social world is more complex and less predictable for an individual with autism, and therefore more stress producing. • 2. Do not assume that simple exposure to peers will result in the acquisition of social skills. • 3. A child cannot be pushed to acquire social skills. Begin with something short, structured, teacher directed, and success oriented.

14. Behavioral Characteristics • Restrictive repetitive and stereotypic patterns of behavior interests or activities.Individuals are often intensely preoccupied with one subject or activity like spinning objects. They can engage in non-functional routines or rituals.

15. Sensory Difficulties. • Individuals are extremely sensitive or are extremelyinsensitive to sensory information. They canoverreact to the fire alarm and not respond when they are injured.

16. Sensory Implications • 1. Be alert to how the sensory environment may be impacting on your student. • 2. Try to keep the environment as low key as possible (e.g., visually clear, sound absorbing materials, no extraneous noise or conversation; balance lighting needs for children’s visual impairment with those of arousal). • 3. Be aware of possible multi-sensory input issues and adjust instruction accordingly. • Confusion concerning ASDVI is often because of similar characteristics between ASD and children who are congenitally blind. Namely echolalia and stereotypic mannerisms.

17. Assessment • ASD assessments contain many “visual” tasks. Those who conduct assessments do not have experience with children who are blind to know what is typical. Sometimes using the Sensory Profile from the DAYC helps to get the conversation started in regards to the fact that there is something else going on besides the visual impairment. Assessments should be conducted in conjunction with a teacher of the visually impaired.

18. ASDVI • Remember, it is a brain-based disorder so those children with neurological vulnerabilities (e.g., Seizure Disorders, Septo-Optic Dysplasia, Prematurity associated with bleeds, Agenesis of the Corpus Callosum, Congenital Rubella Syndrome, Anophthalmia, Leber’s Congenital Amaurosis, etc.) may be at increased risk.

19. Comparing Strategies for the Blind vs. Blind Autistic Student For a blind child: • ·Use a lot of language paired simultaneously with object exploration. • ·Use a lot of vestibular input, tactual input. • ·Moderate levels of extraneous noise generally will not cause distraction. • ·Comparing Strategies for the Blind vs. Blind Autistic Student • ·Provide lots of social stimulation. The child can be expected to enjoy a variety of social contacts. • His sensitivity to social reinforcement, including withdrawal of attention, means that praise and “time out” will be effective motivators

20. Comparing Strategies for the Blind vs. Blind Autistic Student • For a child with ASDVI: • ·Balance social time with alone time. Child may often find social experiences aversive rather than reinforcing. • ·Social experience is generally not important to child. Praise, “time out,” are typically not effect motivators. • · Components of Structured Teaching • ·Physical Structure • ·What activity will occur in “X” location? • ·        What sensory sensitivities need to be addressed by the physical structure?

21. For a child with ASDVI: • ·Use Schedules • ·What will we do? • ·        In what order? • ·Use Individual Work Systems • ·What am I going to do? • ·How much will I do/for • how long? • ·When will I be finished? • What comes next?

22. ASDVI Strategies • ·Need for sameness • ·Use structure, schedule, routines • ·Prepare for change in advance (2 minute warning) • ·Re: restricted interests/anxiety – identify set times to engage in those behaviors. • Use interests to teach skills and content. • Support Communication/Language Comprehension

23. ·Avoid metaphors, words with double meanings; or teach meaning directly; true even for math ·Be concrete presenting new concepts, abstract material • ·Verify comprehension of words child is using, read the child’s cues • ·Use visual supports (print, Braille, picture) • ·When speakingkeep it simple, specific,short, pause. Do not over prompt.      

24. Sensory Sensitivities • ·Monitor, minimize extraneous noise (e.g., voices, equipment), visual distractions (within classroom, hallway, cafeteria, gymnasium, recess) • ·Be aware that even normal levels of auditory and visual input may be perceived as “too much” or “too little” • ·Monitor temperature changes as some children are heat/cold sensitive • Monitor smells (e.g., cleaning fluids, cafeteria smells, perfumes, cosmetics)

25. Motor skills • May do better with fitness or individual sports vs. competitive sports • Monitor written work, develop compensatory skills. • May be clumsy or extremelyagile and have no sense ofdanger.

26. Social Rules • ·Support Social Skills Development • ·Teach coping strategies: • ·Teach key phrases (e.g., “no big deal…” “not whether win or lose but how play the game”) • ·Provide positive/corrective feedback • ·Teach self-talk • ·Teach relaxation      • ·Social stories • ·Provide “safe place” across environments

27. Processing and Sensory Needs • Use controlled language, minimize extraneous noise through use of sound absorbing materials (e.g., tennis balls on bottom of chair feet, hang sound absorbing materials from windows and walls, replacing faulty buzzing fluorescent bulbs, staff to use conversational tones only); use barriers (e.g., book cases) to define space, provide visually and auditorily calm environment.

28. Theory of Mind • The child is shown two dolls, Sally and Anne, playing with a marble. The dolls put away the marble in a box, and then Sally leaves. Anne takes the marble out and plays with it again, and after she is done, puts it away in a different box. Sally returns and the child is then asked where Sally will look for the marble. The child passes the task if she answers that Sally will look in the first box where she put the marble; the child fails the task if she answers that Sally will look in the second box, where the child knows the marble is hidden, even though Sally cannot know, since she did not see it hidden there. In order to pass the task, the child must be able to understand that another’s mental representation of the situation is different from their own, and the child must be able to predict behavior based on that understanding.

29. Material from… • ·Workshops of T. Pawletko, Ph.D. & L. Rocissano, Ph.D., July, 2000 • ·Autism Spectrum Disorders and Visual Impairment, AFB Press. M.H. Gense & D. J. Gense, 2005 • All Cats Have Asperger’s Syndrome. K Hoopman, 2006